General Policy Conditions of Our Critical Illness Policy
It is essential that you are aware of this general policy conditions since this will help you understand the requirements of IFFCO Tokio’s critical illness insurance policy:
1. Conditions Precedent: Where this Policy requires you/your family member(s) named in the Schedule to do or not to do something, then the complete satisfaction of that requirement by you or someone claiming on your behalf is a precondition to any obligation We have under this Policy. If you or someone claiming on your behalf fails to completely satisfy that requirement, then We may refuse to consider Your claim. You/your family member(s) named in the schedule will cooperate with IFFCO Tokio at all times.
2. Reasonable Precautions: You/Insured Person shall take all reasonable precautions to prevent injury, illness, and disease in order to minimize claims against this critical illness cover.
3. Notice: You /Insured Person will give every notice and communication in writing to OUR office through which this insurance is affected.
4. Disclosure to information norm: The critical illness cover shall be void, and all premiums paid hereon shall be forfeited to the Company in the event of misrepresentation, misdescription or non-disclosure of any material facts.
5. Changes in Circumstances: You must inform IFFCO Tokio, as soon as reasonably possible of any change in the information you have provided to IFFCO Tokio about Insured Person(s) which may affect the Insurance cover provided e.g. duty, business, occupation.
6. Claim Procedure and Requirements: This critical illness cover provides for Cashless facility at the network hospitals. The provision of Cashless is at the discretion of IFFCO Tokio / Third Party Administrator keeping in mind the coverage provided under this Policy. In case of the treatment being taken without cashless, the claim will be processed on a reimbursement basis as per the terms and conditions of the policy. Notification of Claim An event, which might become a claim under the Policy, must be reported to IFFCO Tokio as soon as possible, but no later than 14 days from the date of discharge from hospital after treatment of the Critical Illness.
A written statement of the claim will be required and a claim form will be provided and the claim must be filed within 30 days from the date of discharge from Hospital post-treatment of the Critical Illness except for in extreme cases of hardship where it is proved to Our satisfaction that under the circumstances, in which you, the Insured Person or his/her personal representative were placed, it was not possible for anyone of you to give notice or file claim within the prescribed time limit.
The Insured Person must give all bills, receipts, certificates, information, and evidence from a Medical Attendant or otherwise required by the US in the manner and form as IFFCO Tokio may prescribe. In the instances of such claims against the critical illness cover, our representative shall be allowed to carry out examination and obtain information in case of alleged injury or disease if and when we may reasonably require.
7. Assignment: This Policy may not be assigned. Compensation shall be payable only to the Insured person or the Insured Person‘s legal representative whose receipt shall be effective discharge to IFFCO Tokio
8. Contribution if, when any claim against the critical illness cover arises, there is in existence any other Insurance covering the same loss/liability, compensation, costs or expenses, we will pay only our rateable proportion of the claim.
9. Renewal: The online critical illness policy may be renewed by mutual consent every year and in such event, the renewal premium shall be paid to Us on or before the date of expiry of the Policy or of the subsequent renewal thereof. However, We shall not be bound to give notice that such renewal premium is due, provided however that if you apply for renewal and remits the requisite premium before the expiry of this Policy, renewal shall not normally be refused, unless We have reasonable justification to do so. The Policy has to be renewed within the expiry date or within a Grace Period of 30 days from the expiry date, beyond which the continuity benefits will not be available and any insurance cover thereafter will be treated as fresh cover. In any case, we shall not be liable to pay a claim occurring during the period of break-in insurance.
10. Cancellation: We will not ordinarily cancel the critical care insurance policy unless it is a case of mis-representation or concealment of material fact. In case of cancellation of the policy due to the above reasons, policy shall be void and all premium paid thereon shall be forfeited to the Company and the same shall be communicated to you by sending a 15 (Fifteen) notice by registered Post to your last known address You may cancel the Policy by sending at least 15(Fifteen) days written notice to us under Registered Post. We will then allow a refund on a given scale provided there is no claim. Where the claim is preferred, no refund will be made.
11. IFFCO Tokio will not be bound to take notice or be affected by any notice of any trust, charge, lien, assignment or other dealings with or relating to this policy. Your receipt or receipt of Insured Person shall in all cases be an effective discharge to us.
12. Arbitration should any dispute arise between you and us on the quantum of Amount payable (liability being admitted by us), such dispute will be referred to Arbitrator to be appointed in accordance with statutory provisions of the country in force at that time. Further, if when any dispute is referable or referred to arbitration, the making of an award by arbitration, shall be a condition precedent to any right of action by you against us.
13. Disclaimer Clause: If we shall disclaim our liability in any claim and such claim shall not have been made subject matter of suit in a court of law within 12(twelve) months from date of disclaimer, then the claim shall for all-purpose be deemed to have been abandoned and shall not thereafter be recoverable under this Policy.
14. No sum payable under this critical illness insurance Policy shall carry any interest/ penalty. 16. The geographical scope of this Policy will be India.
15. Free Look Period: The free look period for this critical illness cover shall be applicable at the inception of the policy and me. The insured will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable; ii. If the insured has not made any claim during the free look period, the insured shall be entitled to. A refund of the premium paid less any expenses incurred by the insurer on medical examination of the insured persons and the stamp duty charges or; b. Where the risk has already commenced and the option of return of the policy is exercised by the policyholder, a deduction towards the proportionate risk premium for the period on cover or c. Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period.
16. Alteration of Policy Conditions: The policy terms and conditions for this critical illness insurance may undergo alteration as per the IRDA Health Regulation. However, the same shall be duly notified to you at least three months prior to the date when such alteration or revision comes into effect by registered post at your last declared correspondence address. The timeliness for revision in terms and rates shall be as per the IRDA Health Regulation.
17. Withdrawal of Policy: This critical care insurance product may be withdrawn with the prior approval of the Authority and information of withdrawal shall be given to you in advance as per the IRDA guidelines with details of options provided by us. If we do not receive your response on the intimation of withdrawal, the existing product shall be withdrawn on the renewal date and you shall have to take a new policy available with us, subject to portability conditions.